Notes From the Field: Frontline Health Care COVID-19 Response

Stressed is an understatement.

Most infectious disease epidemiologists have been saying for years that it was a matter of when, not if, a pandemic would happen… and here we are.

For so many of us working in health care, it is a challenging time—not just because we’re in the middle of a pandemic—but because there are unanticipated stressors to the health care system.

From the perspective of this infection preventionist, here are some things from the frontline.

There’s no way to avoid the subject of personal protective equipment (PPE). The shortages— especially of masks, both N95 and surgical—are stressing hospitals and health care workers alike.

Extended and re-use of materials is not necessarily a new practice but rather one that was reserved for pandemic response, which means nearly no one has been in this situation before. As federal efforts are underway to open up the Strategic National Stockpile and deploy more PPE, it does little to calm the fears that clinical staff are experiencing. This is perhaps one of the hardest things to tackle.

The isolation precautions required for COVID-19 suspected or confirmed cases are not part of a new strategy. Health care workers have been utilizing these tools and processes for decades. What is new though, is doing so with a novel disease and with the expectation that they extend the use of their masks despite that infection preventionists saying otherwise for years.

The challenge is explaining to staff that N95 masks have been rated for longer use, but we never actually had to employ such tactics. The ability to protect oneself during this time is critical and hospitals are working diligently to maintain sustainable levels. Now is the time that hospital leaders, supply chain, and infection control are working together to evaluate usage and ensure staff have masks for those necessary situations.

Unfortunately, when coupled with the intense and continued media attention, it can feel daunting and frankly more exhausting. These are the times where frontline staff benefit the most from continued conversations, to not only educate, but also answer their questions and calm their fears. Hearing about entire cities being told to shelter in place and masks being sewn by volunteers, would make anyone stressed. From hospital leadership to infection prevention, this has been a big piece in responding to COVID-19.

Another piece to this has been the unsteady rollout of diagnostic testing. As commercial laboratory capabilities have increased in the last week or so, this has opened up the floodgates to testing. Unfortunately, these new capabilities require process development to ensure results are being entered into the electronic medical records and medical providers can stay informed.

With laboratory testing taking several days to a week, this can increase the strain on PPE and frustrations of staff. How can we transfer patients ready for discharge to long-term care facilities if their COVID-19 labs are still pending? What about organ donation? These are the increasingly nuanced aspects of a novel outbreak with a slow laboratory rollout.

In the face of these challenges, it has become apparent what we truly need. Not only PPE, but also rapid bedside diagnostics and greater hospital capacity for critically ill patients.

There are considerable concerns regarding the ability to care for large volumes of patients requiring intensive care units, not only in relation to beds and supplies. How many ventilators does your intensive care unit have? What are your ECMO capabilities? These are just a handful of the concerns being flagged right now.

In a time that has shown a desperate need for greater pandemic prevention and response at a national level, these frontline hospital challenges are just the tip of the iceberg. This is not a sprint, but rather a marathon and it is critical we work together to keep patients and staff safe, taking innovative approaches to PPE utilization and hospital pandemic response.